The Forgetting - Alzheimer’s and the Meaning of Loss (Review)

The Forgetting: Alzheimer's: Portrait of an Epidemic

By David Shenk

290 pp $24.95

Reviewed by Colman McCarthy

In 1982, President Ronald Reagan proclaimed November "National Alzheimer's Month." At a well-attended proclamation ceremony at the White House, Reagan asked one of the medical experts from the National Institutes of Health, "What is Alzheimer's Disease?"

After hearing the explanation about plaques that researchers believe deprive nourishment for the brain's neuron cells, Reagan said, "All I know is that my mother died in a nursing home and she didn't recognize me at the end."

Twenty years later, the former president himself is now in the advanced disintegrating stages of cognitive loss. No longer seen in public, and neither able to talk with or recognize his caregivers, he is the nation's best-known Alzheimer's patient.

Reagan's story is one of many recounted by David Shenk in "The Forgetting." Others who met similar fates include Ralph Waldo Emerson, Jonathan Swift, and Frederick Law Olmstead. Today about 15 million people around the world have Alzheimer's, most of them older than 65, Shenk writes. It's as if over time, potholes develop between the conduits in the brain, muddling the pathways so that brain signals falter. In time, people forget the details that make up their daily life: their routines, their habits, even the memories of who they are. Eventually they lose their most basic ability to care for themselves.

By carefully researching the disease over a period of years, including interviewing patients, families, doctors, and scientists, Shenk braids reportage, analysis, and personal commentary into a coherent whole that leaves the reader both educated and terrified.

After all, what fated roll of the dice might not bring up anyone's number -- yours, mine -- and place us among the 5 million Americans now lost to Alzheimer's? Who also in their 50s, 60s or 70s can say with certainty that today's casual moments of forgetfulness ("Where'd I put my keys?") will not become tomorrow's tug on the brain's curtain as it closes into darkness? "Alzheimer's disease overtakes a person very gradually," Shenk writes, "and for a while can be indistinguishable from mild memory loss. … The first few slips get chalked up to anxiety or a lousy night's sleep or bad cold. But how to consider these incidents of disorientation and confusion when they begin to occur with some frequency? What began as isolated incidents start to mount and soon become impossible to ignore. In fact, they are not incidents; collectively, they are signs of a degenerative condition. Your brain is under attack."

The disease takes its name from Alois Alzheimer, the attending doctor and senior physician at Germany's Frankfort Hospital for the Mentally Ill and Epileptics in 1901. That year, the 37-year-old neuropathologist took on a new patient, a woman in her early 50s. Puzzled by her illness -- disorientation, delusions, incoherency -- Alzheimer ruled out Parkinson's, Huntington's disease, schizophrenia and other neurological disorders. After the woman's death in 1906, Alzheimer examined her brain microscopically. He discovered a jumble of brown clumps, tangles of fibers within neurons, and plaques that form outside. Both, he realized were harbingers of Alzheimer's. What caused the accumulation in the brain's frontal cortex? The doctor didn't know.

Nearly a century later, modern medicine is still on the hunt for a full answer, "The Forgetting" displays Shenk's reportorial skills in probing for enlightenment among professionals who want to know. In lucid prose, he describes the Washington politics of Alzheimer's funding, the research battles among overly competitive scientists eager for breakthrough solutions and big-money payoffs, and the natural curiosity of the baffled layperson.

"Why are so many people fascinated by Alzheimer's disease?" Shenk asks. "Because it is not only a disease, but also a prism through which we can view life in ways not normally available to us. Through the Alzheimer's prism, we can experience life's constituent parts and understand better its resonances and quirks. And as the disease relentlessly progresses toward the final dimming of the sufferer, it forces us to experience death in a way it is rarely otherwise experienced. What is usually a quick flicker we see in super slow motion, over years. It is more painful than many people can even imagine, but it is also perhaps the most poignant of all reminders of why and how human life is so extraordinary. It is our best lens on the meaning of loss."

One reason for public's fierce interest in Alzheimer's may be its devastating potential to future generations. Longevity is now a given in the developed world. Nine out of 10 of today's newborns are expected to live beyond 65, while life expectancy a century ago was in the low 40s. Shenk notes this: "It is the paradox that the extension of life inevitably yields new suffering. Alzheimer's is perhaps the perfectly poignant emblem of this medical quandary. As we defeat disease, we also create disease. Any particular illness may be conquered, but mortality is unavoidable."

The importance of “The Forgetting, aside from an engaging literary style,” is that it comprehensively pulls together both the latest findings from the field and the counsel of medical specialists on activities that might—and a tentative might at that—reduce the risk of getting the disease or delay its onset.

Although Shenk is clearly an intellectual enthused by the challenge of exploring what is to date an unanswerable mystery, he does break stride in one of the final chapters by passing along a few morsels of counsel from the certified specialists in the medical field on activities that might -- and a tentative might at that -- reduce the risk of getting the disease or delay its onset. Get plenty of sleep, avoid fatty foods, exercise, keep an eye on blood pressure, eat foods rich in antioxidants like spinach, broccoli, oranges, blueberries, strawberries, brussels sprouts, and red grapes, and keep your mind active.

One piece of advice, though, borders on the loopy: "Read, discuss, debate, create, play word games, do crossword puzzles, meet new people, learn new languages.” Are we to conclude that playing 300 games of Scrabble a year, and with 20 percent of them having scores over 500 points, will reduce the risk of Alzheimer's? Or breezing through the Sunday New York Times crossword puzzle in 30 minutes means that plaques will never get their sinister way in the brain?

Only a few of us are blessed with lives of both quality and quantity. Scott Nearing, the homesteading self-reliant writer and vegetarian lived to 100, with as a full an intellectual and physical life as in his 30s and 40s. He was rare. But whether or not eating wholesomely, exercising our flesh and bones, and keeping the mind nimble are effective preventions against Alzheimer's is still speculative, those should be choices that anyone of rational bent ought to embrace.

By 2050 about 15 million Americans will have the disease, by then sure to be a more pressing issue. In the meantime, the major hope in research. Before he succumbed to what was then called dementi, Emerson wrote: "When nature has work to be done, she creates a genius to do it."

-- Colman McCarthy, a former Washington Post columnist, directs the Center for Teaching Peace in Washington, DC. The author of five books on social justice, his next one is titled "I'd Rather Teach Peace."